What are surgical means of reducing obesity? – Part 2

• Surgical means can lead to a sensible rate of weight loss is around 0.5kg to 1kg (1lb to 2lb) a week.
• To achieve this, you need an energy deficit of 3,500kcal to 7,000kcal a week, which means eating 500 to 1,000 fewer calories a day.
• You can do this by replacing high-fat foods with those that are low in fat. They are such as:
– Fruit and vegetables
– Unrefined carbohydrates
– Lower-fat dairy products
– Being more physically active
• It’s also important to watch the size of your portions.
• There are few drugs for obesity, and their effect is limited, so doctors have increasingly been looking at other ways to help.

Does surgery for obesity work?

• There is no doubt that surgery can be an effective way to lose large amounts of weight.
• After gastric band surgery, about 40 to 60 per cent of excess weight may be lost.
• Slightly more weight may be lost after a Roux-en-Y.Surgery has been shown to considerably reduce the risks of obesity-related conditions such as:
– Diabetes
– High blood pressure
– Heart attack
– Stroke
– Sleep apnea
– Arthritis
• Surgery reduces the risk of dying from these conditions by 30 per cent or more.
• It can rapidly reverse Type 2 diabetes, sleep apnea and gastric reflux.
• Bariatric surgery also brings psychological benefits, from better mood, self-esteem and relationships to improved work performance.
• Some people develop large folds of loose skin after losing large amounts of weight.

What are risks of obesity surgery?

There are also many possible complications including:
• Risks of an operation such as deep vein thrombosis or post-operative pneumonia.
• Long term nutritional deficiencies such as Vitamin B12, folate and iron.
• Leakage of gastrointestinal contents from the operation site.
• A condition called ‘dumping syndrome’ might develop. This is an unpleasant reaction every time food with high sugar content is eaten. The symptoms include feeling light-headed, sweaty, bloating and abdominal discomfort.
• After Roux-en-Y, a person typically has a one in ten chance of needing to be admitted to hospital within a month.
• The complications include infection, haemorrhage, and strictures.
• Mechanical complications such as an internal hernia are rare but nutritional problems such as thiamine and calcium deficiency are considerable.
• There is also an increased risk of gallstones.
• After a gastric band, mechanical complications are more frequent than with Roux-en-Y.
• They are often less severe and include poor weight loss due to band leakage. This is true in seven to eight per cent of patients.
• Pain/vomiting/food intolerance due to an over-tight band in six to seven per cent is observed.
• Other risks include erosion or pressure ulcer, and gallstones.
• A significant number of people need to have their band adjusted soon after the operation.

Who might benefit from surgery for obesity?

Surgery should only be considered as a ‘final option’ when someone has severe obesity. These are the cases with a BMI over 40 and are not responding to these symptoms:
• People with a BMI of 35-40 may be eligible
• It is more important if they have other high risk conditions such as:
– Type 2 diabetes
– High blood pressure
– Cardiovascular disease
– Osteoarthritis
– High blood lipids
– Sleep apnea
• Those who are very severely overweight, with a BMI over 50, bariatric surgery may be considered as a first line option.
• Some experts, faced with growing numbers of obese people unable to lose weight through diet and exercise who need costly treatment for related conditions, are calling for earlier use of surgery.
• They recommend techniques such as the gastric band which is simpler and cheaper.